Freeze sends chill through bulk billing

The freeze on Medicare patient rebates is affecting more and more GPs, says the AMA's Dr Michael Gannon

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The latest Medicare statistics – for the June-September quarter – give the first major indication that the freeze on Medicare patient rebates is influencing the billing practices of more and more GPs.

These are the first Medicare stats since the July election, and they confirm what the AMA has been saying for some time – the freeze will hurt doctors and patients.

The proportion of GP visits bulk billed fell from 85.9% to 85.4% – still high, but falling for the first time in a while.

At the same time, patient out-of-pocket costs continued to rise, up 4.5% to reach an average of $34.61, creating a double whammy for patients.

There is no doubt that many GPs continue to bulk bill their most vulnerable patients – the poor, the elderly, and the chronically ill.

While the AMA has urged caution in reading too much into one quarter’s figures, the results could be the first confirmation of fears that government policy is pushing up the cost of seeing a GP.

We know that the patient rebate is in many cases inadequate to maintain high-quality medical practice.

In their search for ways to remain viable, practices appear not only to be cutting back on bulk billing, but also looking to charge their non-bulk billed patients more.

Government figures show the average patient contribution increased at more than six times the pace of inflation in the September quarter, a heavy financial blow to households already stretched by near-stagnant wage growth, fuelling fears that patients will increasingly defer or forgo seeing a doctor.

The AMA maintains the bulk-billing rates alone should not be used as a measure of the effectiveness of primary care or the health system as a whole. We urge both sides of politics to move away from their simplistic obsession with it. There are many factors at play.

Nevertheless, these latest figures highlight the importance of Medicare rebates in underpinning the funding of primary health services, and the consequences when they fail to keep pace with the cost of providing care.

The patient rebate is completely inadequate – as it has been for decades – as the total fee for a high quality medical service. It does not reflect the complexity, necessity, or value of the services provided by doctors across the board, not just GPs.

The statistics show that Australians pay above-average out-of-pocket expenses, which is a sure sign that MBS patient rebates are not reflecting or rewarding contemporary, high-quality primary healthcare.

Medicare rebates have been frozen since 2014, and under current plans will not be indexed until at least 2020.

The freeze, along with other policies affecting general practice, was a major factor at this year’s federal election. Unless addressed, it will be a vote changer at the next election too.

I have remarked on a number of occasions that I would be very surprised if the Turnbull government went to the next election with the freeze still in place. The AMA wants the freeze lifted immediately, and the government is very aware of the angst it is causing among GPs and the impact it is having on patients.

I have directly lobbied Prime Minister Turnbull and Health Minister Ley to immediately end the freeze. The AMA has been warning other government ministers and backbenchers that the freeze is eroding the Coalition’s political credibility on health. The message is getting through.

While both Minister Ley and Minister Gillespie have talked down hopes that the policy could be reversed soon, arguing the government cannot afford to recommence indexation until its finances improve, the pressure to act will grow.

The reality is that the health budget is nowhere near being “out of control”. It is sustainable. Primary care represents only 6% of the total health budget.

The AMA agrees the government should work to get the federal budget back to surplus, but cutting health services or shifting costs on to patients is not the best, nor wisest, strategy.

Investing in quality primary care will ultimately deliver savings to the budget through increased economic productivity. Supporting GPs, and the way they care for the patients, is not only morally right, it is economically smart.

The medical profession must be trusted and consulted in the development of good health policy. The Medicare freeze is not good health policy.

As unrest continues to reign in the health sector, the May 2017 budget is taking on huge economic and political survival significance for
the government.

Dr Michael Gannon is President of the AMA